Study of an Intervention to Improve Problem List Accuracy and Use (MAPLE)

The aim of this study is to identify patients with problem list gaps and intervene to correct these gaps by creating clinical decision support interventions that alert providers to likely problem list gaps and offer clinicians the opportunity to correct them. The investigators will randomize the clinics that will receive the intervention and formally evaluate the study after a period of 6 months for improved problem list completeness to determine the effectiveness of our intervention.

The clinical problem list is a cornerstone of the problem-oriented medical record. Problem lists are used in a variety of ways throughout the process of clinical care. In addition to its use by clinicians, the problem list is also critical for decision support and quality measurement. Patients with gaps in their problem list face significant risks. For example, if a hypothetical patient has diabetes properly documented, his clinician would receive appropriate alerts and reminders to guide care. Additionally, the patient might be included in special care management programs and the quality of care provided to him would be measured and tracked. Without diabetes on his problem list, he might receive none of these benefits. In this study, the investigators developed an clinical decision support intervention that will identify patients with problem lists gaps. The investigators will alert providers of these likely gaps and offer providers the opportunity to correct them.

Attention Deficit Disorder With Hyperactivity, Asthma, COPD, Breast Cancer, Coronary Artery Disease, Congestive Heart Failure, Diabetes, Glaucoma, Hemophilia, Hypertension, Hyperthyroidism, Hypothyroidism, Myasthenia Gravis, Osteoporosis, Osteopenia, Renal Failure, Renal Insufficiency, Sickle Cell Disease, Stroke

MAPLE is a CDS intervention within the EHR that will alert providers to problem lists gaps and present an opportunity to correct them.

Of those providers who were shown (or who would have been shown, for the control group) the intervention, the number that added a problem across control and intervention groups.

Number of patients with selected problems on their problem list pre and post intervention across intervention and control groups.

For the conditions of interest, the percent of patients that had the problem added during the study period

For those with problems added due to the intervention, the number of new triggered reminders or other clinical actions.

Inclusion Criteria: Independent healthcare provider (physician, NP, PA) Practices at participating site Exclusion Criteria: None

Wright A, Pang J, Feblowitz JC, Maloney FL, Wilcox AR, McLoughlin KS, Ramelson H, Schneider L, Bates DW. Improving completeness of electronic problem lists through clinical decision support: a randomized, controlled trial. J Am Med Inform Assoc. 2012 Jul-Aug;19(4):555-61. doi: 10.1136/amiajnl-2011-000521. Epub 2012 Jan 3.